Senior Audit & Reimbursement Lead Remote (CMS)

Audit & Reimbursement IIILocation: This role enables associates to work virtually full‑time, with required in‑person training sessions. It offers maximum flexibility and autonomy, supporting productivity and work‑life integration. Alternate locations may be considered if candidates reside within commuting distance of an office. Per our policy, candidates not within a reasonable commuting distance will not be considered unless an accommodation is granted as required by law.Job Overview: The Audit & Reimbursement III will support our Medicare Administrative Contract (MAC) with CMS. Under guided supervision, the incumbent will gain experience on complex Medicare cost report and Part A reimbursement issues, participate in contractual workload, and contribute to special projects. The position offers opportunities for professional development and certification.ResponsibilitiesAnalyze and interpret data, making recommendations for change based on judgment and experience.Work independently on assignments with minimal guidance from managers.Prepare detailed work papers and present findings in accordance with Government Auditing Standards (GAS) and CMS requirements.Gain experience with applicable federal laws, regulations, policies, and audit procedures.Respond timely and accurately to customer inquiries.Multi‑task while independently prioritizing work through time management, initiative, project management, and problem‑solving skills.Perform all duties of lower‑level positions as directed by management.Participate in special projects and review work performed by auditors as assigned.Assist in mentoring less experienced associates as required.Perform complex cost report audits, serving as an in‑charge auditor and assisting other auditors.Depending on experience, perform supervisory review of work completed by other associates.Analyze data from providers' trial balances, financial statements, and related healthcare records.Conduct cost report acceptance, interim rate reviews, final settlements, and tentative settlements.Perform complex calculations for payment exception requests and review exception request work papers prepared by others.Participate in more complex appeals-related work, including position papers and jurisdictional reviews.Maintain accurate records by updating logs, case files, and tracking systems.Attend all team meetings, staff meetings, and training sessions.QualificationsBA/BS degree and a minimum of 3 years of audit/reimbursement or related Medicare experience; or an equivalent combination of education and experience.Must meet the CMS residency requirement: living in the United States for at least three of the past five years.Preferred Skills, Capabilities, and ExperiencesDegree in Accounting preferred.Knowledge of CMS program regulations and cost report format preferred.Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred.MBA, CPA or CIA preferred.Must complete required Continuing Education Training where applicable.Valid driver's license and travel allowance may be required.Audit & Reimbursement SeniorLocation: This role enables associates to work virtually full‑time, with required in‑person training sessions. It offers maximum flexibility and autonomy while ensuring essential onboarding and skill development. Alternate locations may be considered if candidates reside within commuting distance of an office. Candidates not within a reasonable commuting distance will not be considered unless an accommodation is granted as required by law.Job Overview: The Audit & Reimbursement Senior will support our Medicare Administrative Contract (MAC) with CMS, handling complex Medicare cost reports and Part A reimbursement. The position offers advanced experience in auditing and financial analysis and opportunities for certification and professional growth.ResponsibilitiesEvaluate work performed by other associates to ensure accurate reimbursement to providers.Assist leads and managers in training and development of associates.Participate in special projects as assigned.Work independently on assignments with minimal guidance from managers.Prepare detailed work papers and present findings in accordance with GAS and CMS requirements.Analyze and interpret data, offering recommendations based on judgment and experience.Perform all duties of lower‑level positions as directed by management.Develop and maintain audit & reimbursement standard operating procedures.Participate in workgroup initiatives to enhance quality, efficiency, and training.Attend all team meetings, staff meetings, and training sessions.Mentor less experienced associates as assigned.Supervise cost report desk reviews and audits.Review complex exception requests and CMS change requests.Supervise workload involving complex Medicare Part A reimbursement areas such as DSH, Bad Debts, Medical Education, Nursing & Allied Health, Organ Acquisition, Wage Index, and all cost‑based principles.Supervise cost report acceptance, interim rate reviews, tentative settlements, and final settlements.Supervise cost report reopenings.Manage caseload of Medicare cost report appeals, including position papers, jurisdictional reviews, PRRB hearings, administrative resolutions, and PRRB or CMS requests.Monitor all communications related to the caseload.Maintain accurate records by updating logs, case files, and tracking systems.QualificationsBA/BS degree and a minimum of 5 years of audit/reimbursement or related Medicare experience; or an equivalent combination of education and experience.Must meet the CMS residency requirement: living in the United States for at least three of the past five years.Preferred Skills, Capabilities, and ExperiencesKnowledge of CMS program regulations and cost report format preferred.Knowledge of CMS computer systems and Microsoft Office Word and Excel strongly preferred.Must complete required Continuing Education Training.MBA, CPA, CIA, or CFE preferred.Demonstrated leadership experience preferred.Valid driver's license and travel allowance may be required.Special ConsiderationsFor roles within the Government Business Division, applicants and incumbents may be subject to additional requirements, including more stringent background checks and specific training.CompensationAudit & Reimbursement Senior: $75,696 to $125,496Audit & Reimbursement III: $63,156 to $104,706Salary range is an estimate; actual compensation may vary based on location, experience, education, and other factors.LocationsMaine; Maryland; Massachusetts; New York; VirginiaElevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.#J-18808-Ljbffr